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This is a hybrid heart disease risk factor post of a podcast with Prof Bruce Lanphear on lead and a piece I was asked to write for the Washington Post on risk factors for heart disease.First, the podcast. You may have thought the problem with lead exposure was circumscribed to children, but it's a much bigger issue than that. I'll concentrate on the exposure risk to adults in this interview, including the lead-estrogen hypothesis. Bruce has been working on the subject of lead exposure for more than 30 years. Let me emphasize that the problem is not going away, as highlighted in a recent New England Journal of Medicine piece on lead contamination in Milwaukee schools, “The Latest Episode in an Ongoing Toxic Pandemic.”Transcript with links to the audio and citationsEric Topol (00:05):Well, hello. This is Eric Topol with Ground Truths, and I'm very delighted to welcome Professor Bruce Lanphear from Simon Fraser University in British Columbia for a very interesting topic, and that's about lead exposure. We tend to think about lead poisoning with the Flint, Michigan, but there's a lot more to this story. So welcome, Bruce.Bruce Lanphear (00:32):Thank you, Eric. It's great to be here.Eric Topol (00:33):Yeah. So you had a New England Journal of Medicine (NEJM) Review in October last year, which was probably a wake up to me, and I'm sure to many others. We'll link to that, where you reviewed the whole topic, the title is called Lead Poisoning. But of course it's not just about a big dose, but rather chronic exposure. So maybe you could give us a bit of an overview of that review that you wrote for NEJM.Bruce Lanphear (01:05):Yeah, so we really focused on the things where we feel like there's a definitive link. Things like lead and diminished IQ in children, lead and coronary heart disease, lead and chronic renal disease. As you mentioned, we've typically thought of lead as sort of the overt lead poisoning where somebody becomes acutely ill. But over the past century what we've learned is that lead is one of those toxic chemicals where it's the chronic wear and tear on our bodies that catches up and it's at the root of many of these chronic diseases that are causing problems today.Eric Topol (01:43):Yeah, it's pretty striking. The one that grabbed me and kind of almost fell out of my chair was that in 2019 when I guess the most recent data there is 5.5 million cardiovascular deaths ascribed to relatively low levels, or I guess there is no safe level of lead exposure, that's really striking. That's a lot of people dying from something that cardiology and medical community is not really aware of. And there's a figure 3 [BELOW] that we will also show in the transcript, where you show the level where you start to see a takeoff. It starts very low and by 50 μg/liter, you're seeing a twofold risk and there's no threshold, it keeps going up. How many of us do you think are exposed to that type of level as adults, Bruce?Bruce Lanphear (02:39):Well, as adults, if we go back in time, all of us. If you go back to the 1970s when lead was still in gasoline, the median blood lead level of Americans was about 13 to 15 µg/dL. So we've all been exposed historically to those levels, and part of the reason we've begun to see a striking decline in coronary heart disease, which peaked in 1968. And by 1978, there was a 20% decline, 190,000 more people were alive than expected. So even in that first decade, there was this striking decline in coronary heart disease. And so, in addition to the prospective studies that have found this link between an increase in lead exposure and death from cardiovascular disease and more specifically coronary heart disease. We can look back in time and see how the decline in leaded gasoline led to a decline in heart disease and hypertension.Eric Topol (03:41):Yeah, but it looks like it's still a problem. And you have a phenomenal graph that's encouraging, where you see this 95% reduction in the lead exposure from the 1970s. And as you said, the factors that can be ascribed to like getting rid of lead from gasoline and others. But what is troubling is that we still have a lot of people that this could be a problem. Now, one of the things that was fascinating is that you get into that herbal supplements could be a risk factor. That we don't do screening, of course, should we do screening? And there's certain people that particularly that you consider at high risk that should get screened. So I wasn't aware, I mean the one type of supplements that you zoomed in on, how do you say it? Ayurvedic?Supplements With LeadBruce Lanphear (04:39):Oh yeah. So this is Ayurvedic medicine and in fact, I just was on a Zoom call three weeks ago with a husband and wife who live in India. The young woman had taken Ayurvedic medicine and because of that, her blood lead levels increased to 70 µg/dL, and several months later she was pregnant, and she was trying to figure out what to do with this. Ayurvedic medicine is not well regulated. And so, that's one of the most important sources when we think about India, for example. And I think you pointed out a really important thing is number one, we don't know that there's any safe level even though blood lead levels in the United States and Europe, for example, have come down by over 95%. The levels that we're exposed to and especially the levels in our bones are 10 to 100 times higher than our pre-industrial ancestors.Bruce Lanphear (05:36):So we haven't yet reached those levels that our ancestors were exposed to. Are there effects at even lower and lower levels? Everything would suggest, we should assume that there is, but we don't know down below, let's say one microgram per deciliter or that's the equivalent of 10 parts per billion of lead and blood. What we also know though is when leaded gasoline was restricted in the United States and Canada and elsewhere, the companies turned to the industrializing countries and started to market it there. And so, we saw first the epidemic of coronary heart disease in the United States, Canada, Europe. Then that's come down over the past 50 years. At the same time, it was rising in low to middle income countries. So today over 95% of the burden of disease from lead including heart disease is found in industrializing countries.Eric Topol (06:34):Right. Now, it's pretty striking, of course. Is it true that airlines fuel is still with lead today?Bruce Lanphear (06:45):Well, not commercial airlines. It's going to be a small single piston aircraft. So for example, when we did a study down around the Santa Clara County Airport, Reid-Hillview, and we can see that the children who live within a half mile of the airport had blood lead levels about 10% higher than children that live further away. And the children who live downwind, 25% higher still. Now, nobody's mapped out the health effects, but one of the things that's particularly troubling about emissions from small aircraft is that the particle size of lead is extraordinarily small, and we know how nanoparticles because they have larger surface area can be more problematic. They also can probably go straight up into the brain or across the pulmonary tissues, and so those small particles we should be particularly worried about. But it's been such a long journey to try to figure out how to get that out of aircraft. It's a problem. The EPA recognized it. They said it's an endangerment, but the industry is still pushing back.Eric Topol (07:55):Yeah, I mean, it's interesting that we still have these problems, and I am going to in a minute ask you what we can do to just eradicate lead as much as possible, but we're not there yet. But one study that seemed to be hard to believe that you cited in the review. A year after a ban leaded fuel in NASCAR races, mortality from coronary heart disease declined significantly in communities near racetracks. Can you talk about that one because it's a little bit like the one you just mentioned with the airports?Bruce Lanphear (08:30):Yeah. Now that study particularly, this was by Alex Hollingsworth, was particularly looking at people over 65. And we're working on a follow-up study that will look at people below 65, but it was quite striking. When NASCAR took lead out of their fuel, he compared the rates of coronary heart disease of people that live nearby compared to a control group populations that live further away. And he did see a pretty striking reduction. One of the things we also want to look at in our follow-up is how quickly does that risk begin to taper off? That's going to be really important in terms of trying to develop a strategy around preventing lead poisoning. How quickly do we expect to see it fall? I think it's probably going to be within 12 to 24 months that we'll see benefits.Eric Topol (09:20):That's interesting because as you show in a really nice graphic in adults, which are the people who would be listening to this podcast. Of course, they ought to be concerned too about children and all and reproductive health. But the point about the skeleton, 95% of the lead is there and the main organs, which we haven't mentioned the kidney and the kidney injury that occurs no less the cardiovascular, the blood pressure elevation. So these are really, and you mentioned not necessarily highlighted in that graphic, but potential cognitive hit as well. You also wrote about how people who have symptoms of abdominal pain, memory impairment, and high blood pressure that's unexplained, maybe they should get a blood level screening. I assume those are easy to get, right?Bruce Lanphear (10:17):Oh yeah, absolutely. You can get those in any hospital, any clinic across the country. We're still struggling with having those available where it's most needed in the industrializing countries, but certainly available here. Now, we don't expect that for most people who have those symptoms, lead poisoning is going to be the cause, right. It'd still be unusual unless you work in an industry, for example, smelting batteries to recycle them. We don't expect it to be real common, and we're not even sure, Eric, whether we should be doing widespread screening. If I looked at this as a population scientist, the real focus should be on identifying the sources. We mostly know where those are here and radically moving it down. Getting rid of the lead service lines, which was such a big part of what President Biden was doing, and it was perfect. For every dollar invested to reduce lead exposure from those lead service lines. Ronnie Levin at Harvard said there'd be a 35-fold return in cost, benefits really, and this has always been true, that reducing lead exposure throughout the past 40 years has always been shown to be amazingly cost beneficial. The problem is operating within a free market health system, even though there's tremendous social benefits, that benefit isn't going to be monetized or privatized. And so, who's going to make those decisions? We hope our government is, but that doesn't always play out.Eric Topol (11:52):Well. What's interesting is, as opposed to the problems we have today that are prominent such as the microplastic, nanoplastics, the air pollution, the forever chemicals, that just keep getting worse, I mean, they are just cumulative. This one, there was tremendous improvement, but it's still not enough. And I guess you're zooming in on the lead lines. That'd be the most important thing to work on today. Another thing that has come up, there's been trials, as you may I'm sure, because all over this field of chelation, there's a trial that was run by the NIH, supported by NH that looked at chelation to prevent coronary disease. Is there any evidence that people who have a problem with lead would benefit from chelation therapy?Bruce Lanphear (12:44):Well, there's two major studies that have been done, and Tony Lamas was in charge of both of them. The first one Trial to Assess Chelation Therapy (TACT) study, it was a randomized controlled trial, not intended specifically to focus on lead, but rather it was to look at sort of this alternative therapy. They found significant benefits about an 18% reduction in subsequent cardiac events. That led to a second study that was just published last year, and it was focused on people who had diabetes. They saw some benefit, but it wasn't significant. So whether that's because there wasn't enough variability and exposure, it's not entirely clear, but we've seen this with lead in IQ deficits in kids where we can show that we can reduce blood lead levels. But ultimately what tends to happen is once you've taken lead out of the blood, some of it's released again from the bone, but you still have all that lead in the bone that's there. You get some of it out, but you're not going to get the bulk of it out.The Lead-Estrogen HypothesisEric Topol (13:47):Right. It's a reservoir that's hard to reckon with. Yeah. Now another thing, you have a Substack that is called Plagues, Pollution & Poverty, and you wrote a really provocative piece in that earlier and April called How Estrogen Keeps Lead - and Heart Attacks - in Check, and basically you got into the lead estrogen hypothesis.Eric Topol (14:10):Can you enlighten us about that?Bruce Lanphear (14:12):Yeah. A lot of the seminal work in this area was done by Ellen Silbergeld, who's a brilliant and somewhat peculiar toxicologist and Ellen for years, I focused on childhood lead exposure, and for years Ellen would tell me, almost demolish me for not studying adults. And because she had found back in 1988 that as women go into menopause, their blood lead levels spike increased by about 30%, and that's where most of our lead is stored is in our bone. And so, as I was thinking about this, it all became clear because blood lead levels in boys and girls is about the same. It's comparable up until menarche, and then girls young women's blood leads fall by about 20%. And they stay 20% lower throughout the reproductive years until menopause. And especially during those first few years around menopause, perimenopause, you see fairly striking increases in the weakening of the bone and blood lead levels.Bruce Lanphear (15:19):So that might very well help to explain why estrogen is protected, because what happens is throughout the reproductive life, women are losing a little bit of lead every month. And estrogen is at its lowest during that time, and that's going to be when blood lead is at its highest because estrogen pushes lead into the bone. Not only that, women lose lead into the developing fetus when they're pregnant. So what Ellen found is that there was less of a spike around menopause for the women that had three or four pregnancies because they had offloaded that into their babies. So all of this, if you put it together, and this is of course in a very short note of it, you can see that lead increases dyslipidemia, it leads to tears in the endothelium of the arterial wall, it's going to increase thrombosis. All of these things that we think of as the classic atherosclerosis. Well, what estrogen does is the opposite of those. It decreases dyslipidemia, it repairs the arterial endothelial wall. So how much of it is that estrogen is protective, and how much is it that it's moving lead out of the system, making it less biologically available?Eric Topol (16:46):Yeah, I know. It's really interesting. Quite provocative. Should be followed up on, for sure. Just getting to you, you're a physician and epidemiologist, MD MPH, and you have spent your career on this sort of thing, right? I mean, is your middle name lead or what do you work on all the time?Bruce Lanphear (17:09):Yeah, I've been doing this for about 30 years, and one of my mentors, Herb Needleman spent 40 years of his career on it. And in some ways, Eric, it seems to me particularly in these very difficult entrenched problems like lead, we don't have any pharmaceutical company reaching out to us to promote what we do. We've got industry trying to squash what we do.Bruce Lanphear (17:35):It really does take a career to really make a dent in this stuff. And in a way, you can look at my trajectory and it is really following up on what Herb Needleman did and what Clare Patterson did, and that was finding the effects at lower and lower levels. Because what we do with lead and most other toxic chemicals, the ones that don't cause cancer, is we assume that there's a safe level or threshold until we prove otherwise. And yet when you look at the evidence, whether it's about asbestos and mesothelioma, air pollution and cardiovascular mortality, lead and cardiovascular mortality, benzene and leukemia, none of those exhibit a threshold. In some cases, the risks are steepest proportionately at the lowest measurable levels, and that really raises some tremendous challenges, right? Because how are we going to bring air pollution or lead down to zero? But at the same time, it also provides these tremendous opportunities because we know that they're causing disease. We know what the sources are. If we could only bring about the political will to address them, we could prevent a lot of death, disease, and disability. I mean, about 20% of deaths around the world every year are from air pollution, lead, and other toxic chemicals, and yet the amount of money we invest in them is just paltry compared to what we invest in other things. Which is not to pit one against the other, but it's to say we haven't invested enough in these.Eric Topol (19:14):No, absolutely. I think your point, just to make sure that it's clear, is that even at low levels, this is of course where most of the population exposure would be, and that's why that's so incriminating. Now, one of the things I just want to end up with is that we know that these are tiny, tiny particles of lead, and then the question is how they can synergize and find particulate matter of air pollution in the nanoplastic, microplastic story and binding to forever chemicals, PFAS. How do you process all that? Because it's not just a single hit here, it's also the fact that there's ability to have binding to the other environmental toxins that are not going away.Bruce Lanphear (20:10):That's right. And in a way, when we talk about lead playing this tremendous role in the rise and decline of coronary heart disease, we can't entirely separate it out, for example, from air pollution or cigarette smoke for that matter, nor plastic. So for example, with air pollution, if we look at air pollution over the past century, up until the 1980s, even into the 1990s, it was leaded, right? So you couldn't separate them. If you look at cigarette smoke, cigarette tobacco in the 1940s and 1950s was grown in fields where they used lead arsenic as an insecticide. So smokers even today have blood lead levels that are 20% higher than non-smokers, and people who are not smokers but exposed to secondhand smoke have blood lead levels 20% higher than non-smokers who aren't exposed to secondhand smoke. So in a way, we should try to tease apart these differences, but it's going to be really challenging. In a way we can almost think about them as a spectrum of exposures. Now with plastics, you can really think of plastics as a form of pollution because it's not just one thing. There's all these additives, whether it's the PFAS chemicals or lead, which is used as a stabilizer. And so, all of them really are kind of integrated into each other, which again, maybe there's some opportunity there if we really were ready to tackle.Eric Topol (21:40):And interestingly, just yesterday, it was announced by the current administration that they're stopping all the prior efforts on the forever chemicals that were initiated in the water supply. And I mean, if there's one takeaway from our discussion, it's that we have to get all over this and we're not paying enough attention to our environmental exposures. You've really highlighted spotlighted the lead story. And obviously there are others that are, instead of getting somewhat better, they're actually going in the opposite direction. And they're all tied together that's what is so striking here, and they all do many bad things to our bodies. So I don't know how, I'm obviously really interested in promoting healthy aging, and unless we get on this, we're chasing our tails, right?Bruce Lanphear (22:31):Well, I think that's right, Eric. And I was reading the tips that you'd written about in preparation for your book release, and you focused understandably on what each of us can do, how we can modify our own lifestyles. We almost need six tips about what our government should do in order to make it harder for us to become sick, or to encourage those healthy behaviors that you talked about. That's a big part of it as well. One of the things we're celebrating the hundredth anniversary. This is not really something to celebrate, but we are. The hundredth anniversary of the addition of tetraethyl lead to gasoline. And one of the key things about that addition, there was this debate because when it was being manufactured, 80% of the workers at a plant in New Jersey suffered from severe lead poisoning, and five died, and it was enough that New York City, Philadelphia and New Jersey banned tetraethyl lead.Bruce Lanphear (23:31):Then there was this convening by the US Surgeon General to determine whether it was safe to add tetraethyl lead to gasoline. One scientist, Yandell Henderson said, absolutely not. You're going to create a scourge worse than tuberculosis with slow lead poisoning and hardening of your arteries. Robert Kehoe, who represented the industry said, we know lead is toxic, but until you've shown that it's toxic when added to gasoline, you have no right to prohibit us from using it. So that is now known as the Kehoe rule, and it's relevant not only for lead, but for PFAS, for air pollution, for all these other things, because what it set as a precedent, until you've shown that these chemicals or pollution is toxic when used in commerce, you have no right to prohibit industry from using it. And that's the fix we're in.Eric Topol (24:27):Well, it sounds too much like the tobacco story and so many other things that were missed opportunities to promote public health. Now, is Canada doing any better than us on this stuff?Bruce Lanphear (24:40):In some ways, but not in others. And one of the interesting thing is we don't have standards, we have guidelines. And amazingly, the cities generally try to conform to those guidance levels. With water lead, we're down to five parts per billion. The US is sticking around with ten parts per billion, but it's not even really very, it's not enforced very well. So we are doing better in some ways, not so good in other ways. The European Union, generally speaking, is doing much better than North America.Eric Topol (25:15):Yeah, well, it doesn't look very encouraging at the moment, but hopefully someday we'll get there. Bruce, this has been a really fascinating discussion. I think we all should be thankful to you for dedicating your career to a topic that a lot of us are not up on, and you hopefully are getting us all into a state of awareness. And congratulations on that review, which was masterful and keep up the great work. Thank you.Bruce Lanphear (25:42):Thank you, Eric. I appreciate it.________________________________________________My Recommendations for Preventing Heart Disease (Markedly Truncated from Text and Graphics Provided in SUPER AGERS)Recently the Washington Post asked me for a listicle of 10 ways to prevent heart disease. I generally avoid making such lists but many people have de-subscribed to this newspaper, never subscribed, or missed the post, so here it is with links to citations:Guest column by Eric Topol, MDThe buildup of cholesterol and other substances in the wall of our arteries, known as atherosclerosis, is common. It can lead to severe plaques that narrow the artery and limit blood flow, or to a crack in the artery wall that can trigger blood clot formation, resulting in a heart attack.While we've seen some major advances in treating heart disease, it remains the leading killer in the United States, even though about 80 percent of cases are considered preventable. There are evidence-based steps you can take to stave it off. As a cardiologist, here's what I recommend to my patients.1. Do both aerobic and resistance exerciseThis is considered the single most effective medical intervention to protect against atherosclerosis and promote healthy aging. Physical activity lowers inflammation in the body. Evidence has shown that both aerobic and strength training forms of exercise are important. But only 1 in 4 Americans meet the two activity guidelines from the American Heart Association: aerobic exercise of 150 minutes per week of at least moderate physical activity, such as walking, bicycling on level ground, dancing or gardening, and strength training for at least two sessions per week, which typically translates to 60 minutes weekly.The protective benefit of exercise is seen with even relatively low levels of activity, such as around 2,500 steps per day (via sustained physical activity, not starting and stopping), and generally increases proportionately with more activity. It used to be thought that people who exercise only on the weekend — known as “weekend warriors” — put themselves in danger, but recent data shows the benefits of exercise can be derived from weekend-only workouts, too.2. Follow an anti-inflammatory dietA predominantly plant-based diet — high in fiber and rich in vegetables, fruits and whole grains, as seen with the Mediterranean diet — has considerable evidence from large-scale observational and randomized trials for reducing body-wide inflammation and improving cardiovascular outcomes.Foods rich in omega-3 fatty acids, such as salmon, also form part of a diet that suppresses inflammation. On the other hand, red meat and ultra-processed foods are pro-inflammatory, and you should limit your consumption. High protein intake of more than 1.4 grams per kilogram of body weight per day — around 95 grams for someone who is 150 pounds — has also been linked to promoting inflammation and to atherosclerosis in experimental models. That is particularly related to animal-based proteins and the role of leucine, an essential amino acid that is obtained only by diet.3. Maintain a healthy weightBeing overweight or obese indicates an excess of white adipose tissue. This kind of tissue can increase the risk of heart disease because it stores fat cells, known as adipocytes, which release substances that contribute to inflammation.In studies, we've seen that glucagon-like peptide (GLP-1) drugs can reduce inflammation with weight loss, and a significant reduction of heart attacks and strokes among high-risk patients treated for obesity. Lean body weight also helps protect against atrial fibrillation, the most common heart rhythm abnormality.4. Know and avoid metabolic syndrome and prediabetesTied into obesity, in part, is the problem of insulin resistance and metabolic syndrome. Two out of three people with obesity have this syndrome, which is defined as having three out of five features: high fasting blood glucose, high fasting triglycerides, high blood pressure, low high-density lipoprotein (HDL) and central adiposity (waist circumference of more than 40 inches in men, 35 inches in women).Metabolic syndrome is also present in a high proportion of people without obesity, about 50 million Americans. Prediabetes often overlaps with it. Prediabetes is defined as a hemoglobin A1c (a measure of how much glucose is stuck to your red blood cells) between 5.7 and 6.4 percent, or a fasting glucose between 100 and 125 milligrams per deciliter.Both metabolic syndrome and prediabetes carry an increased risk of heart disease and can be prevented — and countered — by weight loss, exercise and an optimal diet.As the glucagon-like peptide drug family moves to pills and less expense in the future, these medications may prove helpful for reducing risk in people with metabolic syndrome and prediabetes. For those with Type 2 diabetes, the goal is optimizing glucose management and maximal attention to lifestyle factors.5. Keep your blood pressure in a healthy rangeHypertension is an important risk factor for heart disease and is exceptionally common as we age. The optimal blood pressure is 120/80 mm Hg or lower. But with aging, there is often an elevation of systolic blood pressure to about 130 mm Hg, related to stiffening of arteries. While common, it is still considered elevated.Ideally, everyone should monitor their blood pressure with a home device to make sure they haven't developed hypertension. A mild abnormality of blood pressure will typically improve with lifestyle changes, but more substantial elevations will probably require medications.6. Find out your genetic riskWe now have the means of determining your genetic risk of coronary artery disease with what is known as a polygenic risk score, derived from a gene chip. The term polygenic refers to hundreds of DNA variants in the genome that are linked to risk of heart disease. This is very different from a family history, because we're a product of both our mother's and father's genomes, and the way the DNA variants come together in each of us can vary considerably for combinations of variants.That means you could have high or low risk for heart disease that is different from your familial pattern. People with a high polygenic risk score benefit the most from medications to lower cholesterol, such as statins. A polygenic risk score can be obtained from a number of commercial companies, though it isn't typically covered by insurance.I don't recommend getting a calcium score of your coronary arteries via a computed tomography (CT) scan. This test is overused and often induces overwhelming anxiety in patients with a high calcium score but without symptoms or bona fide risk. If you have symptoms suggestive of coronary artery disease, such as chest discomfort with exercise, then a CT angiogram may be helpful to map the coronary arteries. It is much more informative than a calcium score.7. Check your blood lipidsThe main lipid abnormality that requires attention is low-density cholesterol (LDL), which is often high and for people with increased risk of heart disease should certainly be addressed. While lifestyle improvements can help, significant elevation typically requires medications such as a statin; ezetimibe; bempedoic acid; or injectables such as evolocumab (Repatha), alirocumab (Praluent) or inclisiran (Leqvio). The higher the risk, the more aggressive LDL lowering may be considered.It should be noted that the use of potent statins, such as rosuvastatin or atorvastatin, especially at high doses, is linked to inducing glucose intolerance and risk of Type 2 diabetes. While this is not a common side effect, it requires attention since it is often missed from lack of awareness.A low high-density lipoprotein (HDL) cholesterol often responds to weight loss and exercise. We used to think that high HDL was indicative of “good cholesterol,” but more recent evidence suggests that is not the case and it may reflect increased risk when very high.To get a comprehensive assessment of risk via your blood lipids, it's important to get the apolipoprotein B (apoB) test at least once because about 20 percent of people have normal LDL and a high apoB.Like low HDL, high fasting triglycerides may indicate insulin resistance as part of the metabolic syndrome and will often respond to lifestyle factors.The lipoprotein known as Lp(a) should also be assessed at least once because it indicates risk when elevated. The good news is scientists are on the cusp of finally having medications to lower it, with five different drugs in late-stage clinical trials.8. Reduce exposure to environmental pollutantsIn recent years, we've learned a lot about the substantial pro-inflammatory effects of air pollution, microplastics and forever chemicals, all of which have been linked to a higher risk of heart disease. In one study, microplastics or nanoplastics in the artery wall were found in about 60 percent of more than 300 people. Researchers found a vicious inflammatory response around the plastics, and a four- to fivefold risk of heart attacks or strokes during three years of follow-up.While we need policy changes to address these toxic substances in the environment, risk can be reduced by paying attention to air and water quality using filtration or purification devices, less use of plastic water bottles and plastic storage, and, in general, being much more aware and wary of our pervasive use of plastics.9. Don't smoke This point, it should be well known that cigarette smoking is a potent risk factor for coronary artery disease and should be completely avoided.10. Get Good SleepAlthough we tend to connect sleep health with brain and cognitive function, there's evidence that sleep regularity and quality are associated with less risk of heart disease. Regularity means adhering to a routine schedule as much as possible, and its benefit may be due to our body's preference for maintaining its circadian rhythm. Sleep quality — meaning with fewer interruptions — and maximal deep sleep can be tracked with smartwatches, fitness bands, rings or mattress sensors.Sleep apnea, when breathing stops and starts during sleep, is fairly common and often unsuspected. So if you're having trouble sleeping or you snore loudly, talk to your doctor about ruling out the condition. Testing for sleep apnea can involve checking for good oxygen saturation throughout one's sleep. That can be done through a sleep study or at home using rings or smartwatches that include oxygen saturation in their sensors and body movement algorithms that pick up disturbed breathing.Eric Topol, MD, is a cardiologist, professor and executive vice president of Scripps Research in San Diego. He is the author of “Super Agers: An Evidence-Based Approach to Longevity” and the author of Ground Truths on Substack.*********************°°°°°°°°°°°°°°°°°°°°Thanks to many of you Ground Truths subscribers who helped put SUPER AGERS on the NYT bestseller list for 4 weeks.Here are 2 recent, informative, and fun conversations I had on the topicMichael Shermer, The SkepticRuss Roberts, EconTalk I'm also very appreciative for your reading and subscribing to Ground Truths.If you found this interesting PLEASE share it!That makes the work involved in putting these together especially worthwhile.All content on Ground Truths—its newsletters, analyses, and podcasts, are free, open-access.Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don't hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past three years. Just a week ago we just had nearly 50 interns (high school, college and medical students) present posters of the work they did over the summer and it was exhilarating! Some photos below Get full access to Ground Truths at erictopol.substack.com/subscribe

Des médicaments pour le cœur, le Repatha et le Praluent, ne sont plus disponibles dans de nombreuses pharmacies françaises, laissant les patients démunis. En cause : un conflit sur la prise en charge entre les laboratoires et le Comité économique des produits de santé.Distribué par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 2540: Discover how to manage high cholesterol levels effectively when traditional methods fall short. This insightful discussion unpacks the complexities of cholesterol, its bodily functions, and advanced medication options like Praluent and Repatha, aimed at reducing LDL levels. Learn about impactful lifestyle changes, from diet tweaks to exercise tips, that could enhance medication efficacy and provide substantial health benefits. Quotes to ponder: "Cholesterol isn't just about what we eat; our bodies produce it too because we need some cholesterol floating around in our bloodstream." "The liver makes cholesterol on its own. This is because we need some cholesterol floating around in the bloodstream." "If our cholesterol levels get too high, it increases the risk of blockages in the arteries." Learn more about your ad choices. Visit megaphone.fm/adchoices

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 2540: Discover how to manage high cholesterol levels effectively when traditional methods fall short. This insightful discussion unpacks the complexities of cholesterol, its bodily functions, and advanced medication options like Praluent and Repatha, aimed at reducing LDL levels. Learn about impactful lifestyle changes, from diet tweaks to exercise tips, that could enhance medication efficacy and provide substantial health benefits. Quotes to ponder: "Cholesterol isn't just about what we eat; our bodies produce it too because we need some cholesterol floating around in our bloodstream." "The liver makes cholesterol on its own. This is because we need some cholesterol floating around in the bloodstream." "If our cholesterol levels get too high, it increases the risk of blockages in the arteries." Learn more about your ad choices. Visit megaphone.fm/adchoices

Ever wondered how doctors navigate the murky waters when they're at odds over a diagnosis or medical question? This week's MedEvidence Monday Minute is discussing this intricate dance. Dr. Michael Koren and Kevin Geddings of WSOS St. Augustine Radio peeled back the curtain on medical disagreements and the importance of tailored healthcare plans. As we bid adieu to Heart Month, they also enlightened us on the latest heart health research, including groundbreaking cholesterol treatments, and how patients can get involved without stepping on their primary physician's toes. At MedEvidence, we bridge the gap between complex medical jargon and your everyday health concerns. From the nuances of medical misinformation to the evident nature of healthcare, our conversations with medical experts are an invaluable resource for anyone curious about the behind-the-scenes of medical decision-making and research. You'll come away with a deeper appreciation for the intricacies of medicine and the pivotal role of research in settling those tough debates between professionals. Join us for a thought-provoking journey into the heart of medical science, where we uncover not just the facts but the stories, people, and truths behind them.Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedInWant to learn more checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.com Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

Dr. Ken Berry is a family physician and a well-known advocate for the low-carb, high-fat ketogenic diet. He received his medical degree from the University of Tennessee and has practiced medicine for over 20 years. Dr Berry has been recognized for his work in improving the health of his patients and has been featured in various media outlets, including Fox News and The Huffington Post. Dr Berry is a co-founder of the Physicians for Ancestral Health organization, which aims to promote ancestral health principles in medical education and practice. Additionally, he serves as a board member for the Nutrition Coalition, which advocates for science-based nutrition policy. Dr Berry has authored several books, including "Lies My Doctor Told Me: Medical Myths That Can Harm Your Health," which challenges commonly held beliefs in the medical community and offers evidence-based alternatives. His other books include "The Proper Human Diet" and "Lies My Politician Told Me: A Case Against Big Government and Public-Sector Unions."  In this episode, Dr Berry speaks about the keto diet, the categorization of dieters, and whether or not LDL is harmful to the human body. He will discuss the impact of healthcare and health insurance on our well-being and offer advice on how to get your doctor to listen to you. He will talk about the impact of cooking on nutrition and whether it takes away from the benefits of food. Tune in as we chat about the Keto diet, LDL cholesterol, presenting research studies to your doctor, healthcare and health insurance, and cooking and nutrition. Purchase Lies My Doctor Told Me by Dr Ken Berry: https://amzn.to/429acJs Purchase Kicking Ass After Age 50 by Dr Ken Berry & Zane Griggs: https://amzn.to/43J6FTJ Order Keto Flex: http://www.ketoflexbook.com -------------------------------------------------------- Download your FREE Vegetable Oil Allergy Card here: https://onlineoffer.lpages.co/vegetable-oil-allergy-card-download/ / / E P I S O D E   S P ON S O R S  Wild Pastures: $20 OFF per Box for Life + Free Shipping for Life + $15 OFF your 1st Box! https://wildpastures.com/promos/save-20-for-life-lf?oid=6&affid=132&source_id=podcast&sub1=ad BonCharge: Blue light Blocking Glasses, Red Light Therapy, Sauna Blankets & More. Visit https://boncharge.com/pages/ketokamp and use the coupon code KETOKAMP for 15% off your order.  Text me the words "Podcast" +1 (786) 364-5002 to be added to my contacts list. [04:49] What's the importance of LDL Cholesterol to our body? LDL cholesterol is highly conserved across different species, indicating its importance for life. The immune system uses LDL cholesterol. Low levels of LDL can lead to susceptibility to bacterial infections and cancer. There is ongoing research into the connection between low LDL levels and illness in people, and it has been discovered that some ICU patients have lower LDL levels. Drugs like Repatha and Praluent can drastically lower LDL levels. Still, no long-term safety data has yet to be available, and adverse effects may not always be reported to the database for post-marketing research. [09:17] What are some risks of having high or low LDL levels? Statins have been prescribed for decades, but adverse effects may not be reported until years later. LDL has many functions in the human body, some of which may not have been discovered yet. Studies have shown that people with the lowest LDL levels have higher cancer rates, infectious death, and autoimmune conditions. Some healthcare providers may not understand the human body's basic physiology of LDL cholesterol. [13:57] What's the benefit of presenting research studies to your doctor? Patients can bring research studies to their doctor to start a meaningful dialogue about their medication. Doctors may not be aware of certain research studies due to a lack of time to research every single topic. Pharmaceutical representatives may only present the benefits of medication without mentioning potential side effects or risks. Patients who bring in research studies may see positive results, such as doctors being more willing to adjust their medication dosage or prescribe a different medication. Patients can use their knowledge of research studies to have informed discussions with their doctors about their treatment plans, which could change the trajectory of medical practice. [22:19] Are healthcare and health insurance for better or worse? The healthcare and health insurance business model are not designed to profit from metabolically healthy people who eat a proper human diet. ·   The origins of health insurance can be traced back to the Nixon administration's wage freeze, which led to companies offering it as a fringe benefit to attract employees. Insurance companies saw an opportunity to make millions and created health insurance products with raised deductibles and lower coverage for profit. The current healthcare system in the United States faces challenges, including rising premiums and the debate over universal healthcare. [40:20] Cooking and Nutrition: Does Cooking Take Away the Food's Benefits? Cooking above 120 degrees Fahrenheit can denature some vital vitamins, polyphenols, and phytonutrients in food, but it is typically a small amount. Minerals and electrolytes are not affected by cooking, as they are elements on the periodic table. Cooking unlocks a bunch of nutrients that are not accessible in raw food. The raw food movement failed because it was difficult to consume enough raw plants to provide the body with sufficient nutrition, and people lost weight to the point of becoming unhealthy. Humans have been cooking food for at least 1 million years, and our bodies have evolved to optimize digestion with cooked food. Cooking meat for a medium rare or medium level of doneness mimics our ancestors' ways and provides many benefits with few drawbacks. Resources from this episode:  Purchase Lies My Doctor Told Me by Dr Ken Berry: https://amzn.to/429acJs Purchase Kicking Ass After Age 50 by Dr Ken Berry & Zane Griggs: https://amzn.to/43J6FTJ Website: https://drberry.com/ Proper Human Diet Community: https://phdhealth.community/ Follow Dr Berry Facebook: https://www.facebook.com/kendberry.md/ Twitter: https://twitter.com/KenDBerryMD YouTube: https://www.youtube.com/user/KenDBerry Instagram: https://www.instagram.com/kendberry.md/?hl=en Join the Keto Kamp Academy: https://ketokampacademy.com/7-day-trial-a Watch Keto Kamp on YouTube: https://www.youtube.com/channel/UCUh_MOM621MvpW_HLtfkLyQ Order Keto Flex: http://www.ketoflexbook.com -------------------------------------------------------- Download your FREE Vegetable Oil Allergy Card here: https://onlineoffer.lpages.co/vegetable-oil-allergy-card-download/ / / E P I S O D E   S P ON S O R S  Wild Pastures: $20 OFF per Box for Life + Free Shipping for Life + $15 OFF your 1st Box! https://wildpastures.com/promos/save-20-for-life-lf?oid=6&affid=132&source_id=podcast&sub1=ad BonCharge: Blue light Blocking Glasses, Red Light Therapy, Sauna Blankets & More. Visit https://boncharge.com/pages/ketokamp and use the coupon code KETOKAMP for 15% off your order.  Text me the words "Podcast" +1 (786) 364-5002 to be added to my contacts list. // F O L L O W ▸ instagram | @thebenazadi | http://bit.ly/2B1NXKW ▸ facebook | /thebenazadi | http://bit.ly/2BVvvW6 ▸ twitter | @thebenazadi http://bit.ly/2USE0so ▸ tiktok | @thebenazadi https://www.tiktok.com/@thebenazadi Disclaimer: This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast including Ben Azadi disclaim responsibility from any possible adverse effects from the use of information contained herein. Opinions of guests are their own, and this podcast does not accept responsibility of statements made by guests. This podcast does not make any representations or warranties about guests qualifications or credibility. Individuals on this podcast may have a direct or non-direct interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included a report that insurance coverage gains are reversing; a deal to lower the cost of Praluent for Express Scripts members; findings that synthetic opioids are playing a bigger role in overdose deaths. Increases in Insurance Coverage Rates From ACA Beginning to Reverse: www.ajmc.com/focus-of-the-week/increases-in-insurance-coverage-rates-from-aca-beginning-to-reverse Sanofi, Regeneron to Cut Praluent Prices Under Exclusive Express Scripts Deal That Ends Prior Approval Delays: www.ajmc.com/newsroom/sanofi-regeneron-to-cut-praluent-prices-under-exclusive-express-scripts-deal-that-ends-prior-approval-delays Dr Jay Edelberg on Safety, Efficacy of Praluent and Remaining Payment Challenges: www.ajmc.com/conferences/aha-2017/dr-jay-edelberg-on-safety-efficacy-of-praluent-and-remaining-payment-challenges Synthetic Opioids Overtake Prescription Opioids as Driver of Overdose Deaths in 2016: www.ajmc.com/newsroom/synthetic-opioids-overtake-prescription-opioids-as-driver-of-overdose-deaths-in-2016 FDA Approves CAR T-Cell Treatment Kymriah for Adult B-Cell Lymphoma: www.ajmc.com/newsroom/fda-approves-cart-cell-treatment-kymriah-for-adult-bcell-lymphoma Verma Highlights CMS Initiatives to Empower Patients and Promote Competition: www.ajmc.com/conferences/whcc-2018/verma-highlights-cms-initiatives-to-empower-patients-and-promote-competition Former HHS Secretary Price Identifies a Path to Moving Forward in Healthcare Reform: www.ajmc.com/conferences/whcc-2018/former-hhs-secretary-price-identifies-a-path-to-moving-forward-in-healthcare-reform 15th Annual World Health Care Congress: www.ajmc.com/conferences/whcc-2018

Please like and share with you’re friends. If you know anyone taking Repatha or Praluent please send them my way. I would love to hear there stories!!!

Although statins have a proven benefit and are widely used, ASCVD continues to be the leading cause of death in the US.  In 2015, two proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, alirocumab (Praluent®) and evolocumab (Repatha®), were approved to treat elevated cholesterol when added to maximally-tolerated statin therapy in patients with familial hypercholesterolemia or history of ASCVD.  However, the lack of long-term CV outcomes data, high cost, and uncertainty regarding place in therapy have limited their wide-spread use. The recently published FOURIER Study provides compelling new evidence. Guest Author:  Kelly Starman, Pharm.D., BCPS Theme music by Good Talk.

In this episode, we discuss PCSK9 inhibitors, a new drug class for LDL lowering, with a particular focus on alirocumab (Praluent).

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Dan Perkins will discus the latest developments with the stock market and the what happening in the Oil and Energy Markets. 2nd guest Javier Rodriguez is President and CEO of DaVita Kidney Care will be discussing: Health Care Expert Empowers Patients to Create the Best Treatment Plan. Third Guest Dr. Harold Bays, of Louisville Metabolic and Atherosclerosis Research Center will discuss why the approval and availability of Praluent.This show is broadcast live on W4CY Radio – (www.w4cy.com) part of Talk 4 Radio (http://www.talk4radio.com/) on the Talk 4 Media Network (http://www.talk4media.com/).

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